New city health plan would raise rates, increase access

The city’s employee health-care plan would undergo broad changes under Mayor Teresa Tomlinson’s proposed budget, which would increase employee premiums but open up access to the city’s health clinic to all city employees.

Along with opening the clinic, or Health and Wellness Center, to all employees, the proposal would create a “wellness program” designed to manage chronic conditions that drive up medical costs to both employees and the city and hence, the taxpayers.

The insurance end of the proposal would eliminate the current HMO and PPO plans and replace them with “gold” and “silver” Point of Service plans that would increase costs to employees.

For example, employees switching from the current least expensive plan to the silver plan would see premiums jump from about $60 biweekly to about $73 for individuals. For employee and children, the cost would go from about $104 biweekly to about $128 and for employee and spouse, from about $112 to about $137. For full family coverage, the premium would rise from about $165 to $202 biweekly.

Those opting for the gold plan would see rates rise from $71 biweekly to $105. For employee and children, rates would rise from $124 to $183 and for employee and spouse, from $133 to $197. For full family coverage, it would rise from $197 to $290.

A key part of the new plan is to open the city’s clinic, the Health and Wellness Center, to all city employees, regardless of which plan they choose. Currently only employees who opt for the Health and Wellness plan may use the facility.

Part of increasing employee use of the city clinic is to encourage them to enroll in a wellness program, which would help workers suffering from high-cost conditions, such as hypertension, diabetes, cholesterol, asthma, arthritis and obesity.

Obesity is one the city particularly wants to reduce, because it can contribute significantly to many of the other conditions, said Tammi Starkey, an executive with ShawHankins, the employee benefits consulting firm that handles the city’s plan.

“The CDC says that medical expenses for obese employees average 42 percent more than a person of a healthy weight,” Starkey told Columbus Councilors on Tuesday. “These are lifestyle-related conditions that we are looking to help manage through the wellness program.”

The city is considering options to encourage employees to participate in the program. That could be in the form of a financial penalty for not participating or a financial benefit for participation, Starkey said.

“If we don’t provide an incentive to participate, then we’re not going to touch the employees that need it most,” Starkey said. “We’re looking to reach out to those who are not receiving regular medical care and who do not have a relationship with a primary care physician, so they potentially have conditions that are going undiagnosed.”

Starkey said ShawHankins is recommending a $50 per pay period “surcharge” for employees who refuse to participate in the wellness program or giving a $500 credit to the employees Health Reimbursement Account that could help offset the employee’s deductible.

The options will be presented to a CCG employee focus group and the city’s Employee Benefits Committee to evaluate which one would work best for the Consolidated Government, Starkey said.

A study that ShawHankins performed of another county government that instituted a similar plan showed a reduction in the number of “high cost claimants,” those employees with expensive maladies. It reduced the number of those patients by 40 percent and the cost of treating those by 36 percent, Starkey said. For some perspective, she said treating a heart attack patient costs about $75,000 a year. Treating a stroke victim costs $61,000 a year and a patient with coronary artery disease costs about $72,000 a year to treat.

If Columbus realized a 36 percent reduction in the cost of high cost claimants, it would save the city $1.2 million a year, Starkey said.

Starkey made her presentation to councilors meeting as the Budget Review Committee, reviewing the proposed fiscal 2017 budget. Council will decide on the plan later in the budget process.

This story was originally published May 5, 2016 at 10:24 PM with the headline "New city health plan would raise rates, increase access."